Originally published in Ms. Magazine in Summer 2008, MacArthur Director of Population and Reproductive Health Judith Helzner outlines low-tech, low-cost interventions to protect mothers during childbirth.
A woman lies bleeding in the emergency room of the university of Ibadan College Hospital in Nigeria. Though her baby was delivered safely, she’s suffering from postpartum hemorrhage, an easily treatable condition that nonetheless kills approximately 160,000 women in the global South annually—about 30 percent of all maternal deaths. In the past, this woman would likely have died in as little as two hours.
But today, a low-cost, wet-suit-like outfit can save her. Made of neoprene and Velcro, the AntiShock Garment or LifeWrap (www.lifewraps.org), enfolded around the new mother’s lower body, can decrease bleeding and keep blood in her vital organs. It will help stabilize her, allowing time to transport her to an appropriate facility, for a surgeon to be called or for enough blood to be collected for her transfusion.
This is one of several low-tech, low-cost interventions that could dramatically reduce maternal mortality in the global South, where each year more than half a million women die from preventable pregnancyrelated causes—one every minute. In 2000, the United Nations identified reduction of maternal mortality as one of eight Millennium Development Goals—global priorities designed to help end poverty. Yet this issue is struggling for visibility and funding, lost in the competition for billions of dollars allocated for global health. Consequently, while such innovations as the AntiShock Garment offer women real hope, the challenge is how to make them widely available.
Another helpful postpartum intervention is the inexpensive, uterinecontracting drug misoprostol, which has been shown by research in India to prevent up to half of all postpartum hemorrhaging if administered within a few minutes after delivery. If a woman does start bleeding, the AntiShock Garment then stabilizes her. Or, if a woman suffers from eclampsia due to complications from hypertension— which can lead to convulsions and accounts for about 12 percent of all maternal deaths—she can best be helped by the drug magnesium sulfate. But that remedy is rarely used because of problems with availability, staff training or health-facility readiness.
In the past, experts in the maternal health field have disagreed on priority actions. But within the past year a consensus has emerged on the three pillars necessary to support a sustained drop in pregnancy-related deaths:
- Comprehensive reproductive health care must include contraception to avoid unwanted births and prenatal visits to monitor pregnant women.
- Skilled attendance at birth must mean ensuring that danger signs are identified early for at-home births, or births in modest primary healthcare centers, and that timely actions are taken to prevent complications or to bring women to more sophisticated facilities.
- It is a critical investment to increase capacity for emergency obstetric care, including operating rooms for C-section deliveries and stocked blood banks for transfusions.
These interventions can be funded and introduced without overhauling health systems. Other steps needed to improve maternal health aren’t so clearcut. But based on the billions spent each year on such global health issues as HIV/AIDS—not to mention expenditures for issues other than health— it’s obvious that resources exist.
What’s missing is the political will. For the global community to meet commitments made in the Millennium Development Goals, attention and resources need to be redirected, and greater concern put forth by health experts, government officials and ordinary citizens. As Thoraya Obaid, director of the U.N. Population Fund, noted, “It would cost the world less than two and a half days’ worth of military spending to save the lives of 6 million mothers, newborns and children every year.”